PROJECT SUMMARY Facial transplantation is a relatively new and promising surgical option for people who have suffered severe facial injury and disfigurement. The precipitating events resulting in facial transplantation vary but include chemical burn, electrical burn, animal attack, gunshot, neurofibromatosis, and damage due to oncological treatment and radiotherapy. To date, over 30 facial transplantations have been performed worldwide, seven of them at Brigham and Women's Hospital in Boston. Although facial mobility appears to be slowly improving in these patients, speech deficits persist due to persistent lip muscle weakness. Now that technologic and immunologic feasibility of this surgery have been established, the next steps for improving clinical science and management is to (1) determine baseline rates of facial motor recovery in a cohort of patients, (2) test the efficacy of exercise for improving facial motor and speech outcomes, and (3) improve the accuracy of outcome measures used in clinical assessments, in research on mechanisms of recovery, and in clinical trials of surgical and behavioral interventions. The proposed series of studies addresses each of these needs by leveraging state-of-the-art 3D facial movement tracking technology to quantify recovery post-facial transplantation and to provide real-time feedback of lip movement treatment targets. Our established interdisciplinary team, with expertise in speech-language pathology, motor speech, clinical neurology, and facial transplantation, is well positioned to conduct this research. The findings will (1) advance understanding of functional recovery following face transplantation, (2) identify the most useful outcome measures for use in routine clinical assessments of facial motor function for future clinical trials, and (3) provide preclinical data on the safety, compliance, and efficacy of a home-based lip exercise program. The findings are also likely to be relevant for improving the assessment and treatment of a broad range of other facial motor impairments, both congenital and acquired.